At a certain point in life when one falls seriously ill, or the 55+ crowd is downsizing and retiring to another location or country, or when there are family discussions about assisted living, it becomes clear mortality may be in the offing (hopefully far off) and belongings will be left behind.
Is it possible to prepare for the time-consuming task of divesting now? And could this activity bring a sense of relief to you and your loved ones?
The Gentle Art of Swedish Death Cleaning: How to Free Yourself and Your Family from a Lifetime of Clutter (part of The Swedish Art of Living and Dying series) by Margareta Magnusson, first published in 2017, addresses some of these questions..
Contrary to what the title may infer cleanings take place before your demise. They are intended as an exercise for the living and do not refer to having someone else bear the burden of tending to belongings after your departure.
In Swedish the exercise is döstädning — a combination of the word “dö” (death) and “städning” (cleaning). As Magnusson explains, “Death cleaning is not about dusting or mopping up; it is a permanent form of organization that makes your everyday life run more smoothly.”
Such “cleanings” are a decluttering and organization system not dissimilar from lifestyle trend books and videos such as Marie Kondo’s hugely popular Konmari, a Japanese organizing system (I add European comforts), or centuries old Danish “hygge” and Norwegian “hugga” lifestyles focused on keeping and enjoying all that is cozy and easy. Hugge, a colloquial term in Norwegian, means to comfort, console, or hug, but it may also mean to chop, cut out, or pare down. If you are a minimalist, these concepts are already familiar.
The process is ultimately like spring and fall cleaning. It may also be thought of as mindfulness about what you choose to surround yourself with now. It may also be thought of as a chance to discuss your wishes for end-of-life.
Takeaways from Magnusson’s book:
Start in your 50’s (perhaps any age as it is never too early to be aware)
Contact loved ones and let them know your plans (tag items now)
Create an opportunity to discuss your End-of-Life plans, encourage candid conversation
Begin divesting of less important personal items
Gift possessions away gradually – furniture, books, collectibles, clothing
Keep mementos and items you cherish or are useful – photos, letters, diaries
Donate
Prepare a list of important documents and passwords
Continue decluttering
Initiate a plan for who will inherit your pet or pets
Focus on how this process will ultimately unburden children, executors, and others
Notice how you may feel less stress or feel happier and freer as you do it
This faux painting reminds me of gathering field flowers with my two sisters for our mother. A friend from Mexico loved it the minute he saw it, and it is tagged for him.
Considerations and Outcomes
The word death is off-putting for some but Magnusson’s intention is to invite us to simplify now to prepare for the inevitable – death in this lifetime. It is a practical and sensible way to help us reflect upon our legacies and what we are leaving behind. It is a kindness to those left behind creating a less burdensome aftermath. And to put it into perspective, it is the antithesis of being buried with all your belongings in a tomb for your afterlife as an Egyptian pharaoh. (Yes, the pharaohs left treasures for us to understand their civilization and we thank them).
Learning the Process Through Experience
I had the pleasure of living in Sweden as a student at the University of Stockholm International Graduate School. I rented rooms from older adults. I did not hear, read about, or witness this tradition.
It is not yet clear if döstädning is definitively Swedish, but Magnusson has certainly been the first to claim it as officially Swedish with her book. Based on my experience Swedes tend to be practical and realistic. In Sweden, you are cared for from cradle to grave with your taxes. Your burial is included. Gentle death cleaning makes sense culturally. It seems to be a Scandinavian custom.
Personal Experience
The unexpected demise of my beautiful mother taught me much. My father died, also unexpectedly, when my siblings and I were children. My mother put all her love energy into creating quality of life and fine memories for us to continue. One day she went for a routine surgery and did not survive. She had, however, organized everything just in case – life insurance, bank account, and a holographic will with a list of which heirlooms (paintings, silver, oriental carpets, family treasures) for each child. Even though I continue to choke up when remembering, it was an extraordinary gift of deep love and care. She modeled this concept without ever speaking of it, she had pre-planned all. A few years later, I began little by little to follow her lead.
Another quiet display of döstädning from the Greatest Generation: NOTICE WHEN SOMEONE OLDER STARTS GIVING THINGS AWAY. The action is a clue. It is likely they feel their moments in this lifetime may close in the not-too-distant future.
A lovely 80+ friend in Washington, D.C. called me one day and asked me to please visit. She was clear, “I am contemplating my demise.” Like me, she was a solo adult with no significant other, no children, and few relatives. She insisted I return to California with sacred items from her travels and family. It was an honor to receive the gifts given so tenderly. I treasure them and have marked them for homes with the next generation.
American Tole Tray from Raleigh, North Carolina and Washington, D.C. family via beloved friend, destined for godson and wife who collect antiques, always wished for a French tole tray but this one has far more sentimental value
Another older friend, a neighbor above, was a descendant of a Spanish land grant family. He also lived, as did the fine lady from D.C., an intercontinental and sophisticated life. He too was a solo ager with no spouse or children and insisted on giving me an Austrian tea set, some Mexican silver, and other charming items to enjoy playing house and entertaining with. He died shortly after I received these love mementos.
Even though I shared my heart with my behavior, I wish I had known then how to share what their presence in my life meant to me and had a chance to say goodbye.
I started divesting in my late 40’s because loss (in my life) happens without warning and without time to prepare – sudden deaths of loved ones and friends, accidents, financial disappointments. I cherish my life. I feel my mission has yet to be completed. I carry on with items that bring me the most pleasure or are useful. I am grateful to those that modelled döstädning for me.
Fortunately, there are millennials and Gen-Xers in my life (though not all wish to have possessions) – a niece, a godson with four little children, friends from Oaxaca with extended families, a beloved doctor friend, young women friends and others who thankfully are present to be recipients.
The photo does not do justice to this 1940’s piece from Indian Style with hand-placed fabrics over the poster. Tagged for a doctor friend who loves unusual East Indian and Persian art. Depicted are Krishna and Radha.
If it appeals to you, start with döstädning as a spring and fall cleaning or downsizing so you may focus on quality of life to the end of your life. I suggest starting before you imagine you need to and proceed slowly. You may rediscover meaningful photos, old friends, memories. May you be inspired to find homes for or donate items. Your efforts will be a kindness to those who survive you. Best wishes as you discover and enjoy possible benefits if you have not done so already.
“If you’re an expat, you’re probably already well-versed in the art of doing away with what no longer serves you so that you can make room for new adventures. In Latin America, where ample storage space is more of a luxury than a given, it can be extra important to make sure that one’s physical environment doesn’t suddenly turn into something resembling a dragon’s lair with mountains of “treasure” piled up all around.”
https://www.youtube.com/watch?v=u1TisVCm3D4 A mother (age 65) and her daughter listen to the audible Gentle Swedish Death Cleaning and have fun implementing some of the suggestions.
Wendy Jane Carrel, MA, is a Spanish-speaking senior care specialist and consultant from California. She has travelled Mexico for several years researching and studying health systems, housing, senior care, and end-of-life care to connect Americans, Canadians, and Europeans with healing options for loved ones. She has assessed hundreds of senior living choices in 16 Mexican states. Her web site is https://www.WellnessShepherd.com
“Navigating through Life’s Journey” was the theme for the 3rd annual Beautiful Dying Expo November 12-14 on-line produced by author and end-of-life doula Michele Little and co-produced by Christy Marie.
Over 1300 registrants logged in from 45 countries on five continents to learn or share about quality of life, palliative care, hospice, death, dying, green burial, grief, and more.
Not surprisingly most of the speakers who devote themselves to death and dying education have come to the space as a result of personal experiences with death – physicians, nurses, end-of-life doulas, psychologists, social workers, chaplains, family members, policy makers, and more.
There were many tender moments as well as offerings of humor, healing, practical action plans, and revelation. For many attendees the expo went by far too fast. Over 50 useful talks and exchanges included, among other subjects, how to write a holographic will and why (a holographic will is legal), Latin American perspectives on death, pediatric palliative care, surviving suicide, and veteran burial benefits. There were Death Cafes and a Sudden Widow Coach. Much to choose from!!!
“The timing for our exploration couldn’t have been more perfectly aligned as the past two years have impacted all of us and made us more aware of how precious life is,” stated producer Little.
“We needed a place we could go to find answers for our deep, unspoken questions about dying, death and grief. We needed to know it was okay to live, love, and be in joy.”
There were many highlights but one stand-out (I admit to bias because I know them), was the presentation by Rev. Dr. Saul Ebema and his after chat with producer Michele Little. Ebema survived the south Sudanese war and time as a child soldier to eventually become a hospice chaplain in the U.S. Little’s brother David was a NYC firefighter who lost his life trying to save others on 9/11 in one of the twin towers. His remains were never found. These two sentient beings talked about love, loss, the mysteries of death, and the sacredness of life. It was moving to listen to.
Rev. Ebema’s PTSD from witnessing the unmerciful deaths of his parents, his only brother, and the war still lingers. “I longed for a sense of community, for people to talk to, for people you can dream with, and tried to figure out this thing called life.”
Rev. Ebema reminded the audience that “life is a practice”, “grief and joy can co-exist”, and “being kind saves lives.”
Rev Dr. Saul Ebema is the president and founder of Hospice Chaplaincy. He founded and co-hosts “The Hospice Chaplaincy Show” a podcast about compassion and the psychosocial/spiritual aspects of end-of-life care. See https://hospicechaplaincy.com
Rev. Dr. Saul Ebema of Hospice Chaplaincy
Other speakers among the many (apologies to the amazing guests whom I was unable to listen to, thank you for your contributions):
The main presenter on the first morning was Gary Mallkin, a heart-centered, award-winning musician (20 Emmys) who shared how music may support us as we journey gently through grief. Music for Malkin is “innertainment”. “Everything is vibration and has intention, it can shift our attention, hearing is the last sense to go.” From Malkin’s point of view, “the most successful pharmaceutical would be a pill with music, music as medicine.” His website, featuring many spiritual luminaries may be found at www.wisdomoftheworld.com
Althea Halchuk, a Board-Certified Patient Advocate (BCPA) specializing in health law and founder of End Well Patient Advocacy gave an exceptionally articulate and important talk about Medical Surrogacy – who is going to speak for you if you become incapacitated. This is a subject that should be of interest to everyone, especially people who live alone, have no children, no spouse, no significant other, and no support system. Halchuk is also an advocate for Final Exit Network. She is based in Arizona. https://endingwellpatientadvocacy.com/
Dr. Mitsuo Tumita moderated a talk with Julie Stroud (now an End-of-Life Option Advocate) who witnessed medical aid in dying (MAID) for her father, and Joanne Kelley (now an author, INELDA End-of-Life Doula and End-of-Life Option advocate) who reluctantly witnessed her husband’s transition. They reiterated that no matter how you feel, i.e. you do not agree, you do not want your loved one to die, the dying person’s wishes must be front and center. They spoke of stigma attached to MAID, as well as “how MAID is often mixed up with suicide.”
Arlene Stepputat, a death educator and end-of-life doula from Santa Barbara, CA spoke about “Doulas at the Bedside” based on her experiences companioning over 20 folks on their journeys. “Bedside practice is the best teacher.” Arlene can be found at https://dyingtobegreen.com/resources/divine-doulas/
There were panels of End-of-Life Doulas as well as a presentation by Dr. Jamie Eaddy Chism, Founder of Thoughtful Transitions and INELDA (International End-of-Life Doula Association) Director of Program Development. Chism is devoted to black end-of-life care. See (https://www.thoughtfultransitions.org). Doula discussions included mention of gradual acceptance of their purpose (non-medical) in hospital ICUs, hospices, and private homes.
Author and radio personality Jane Asher hosted “In the Next Room” podcasts. On-line meet-ups in “rooms”, interaction during sessions also included write-in chats in the side bar. A myriad of multi-lingual panels (English/Spanish/Portuguese) were hosted by Wilka Roig of the Elizabeth Kubler-Ross Foundation Central Mexico. A blog about transpersonal psychologist Roig and her death education initiatives in Mexico may be found here https://wellnessshepherd.com/2021/04/30/end-of-life-education-and-end-of-life-doula-training-takes-off-in-san-miguel-de-allende-mexico/
Palliative care physician and gerontologist Karl Steinberg (a speaker at the 2019 and 2020 expos) focused his talk (missed this event) on the importance of bioethics in end-of-life care and also addressed the current controversy about the value of having an Advance Care Plan. Steinberg is the current Vice President of the National POLST (Physician’s Order for Life Sustaining Treatment – known as a MOLST on the east coast).
Ben Janzen, Dr. Theology, PhD, Grief Release Method specialist, Hospice Chaplain, and VITAS Bereavement Counselor, also a speaker in 2019 and 2020, gave a talk which I missed. He also participated in a panel discussion on grief.
Canadian Yvonne Heath of Love Your Life to Death and TedX speaker explored the concept of a joyful death with American physician and comedian Patch Adams. Yes, he is the person portrayed by Robin Williams in a movie with his name.
Terri Daniel, an interfaith chaplain, end-of-life educator, and grief counselor created a spiritual ritual for the opening and closing ceremonies. Daniel is the producer of the original After Life Conference (11th year), producer of the Conference on Death, Grief, and Belief (July 2022), host of Ask Doctor Death podcast. See https://danieldirect.net/
Producer-director Gay Gillingham of Dying to Know, a documentary created over several years of conversations between former Harvard psychology professors Ram Das (Richard Alpert) and Timothy Leary about the meaning of life and death, offered her film as the closing night gift. A link to the trailer and the movie may be found here: https://dyingtoknowmovie.com/
The 2022 Beautiful Dying Expo is scheduled for November 11-13. More information may be found at www.BeautifulDyingExpo.com as well as on the expo Facebook page which features Michelle Little’s interviews with guests dedicated to death, dying, and grief education.
The Beautiful Dying Expo is a non-profit project of the Institute on Violence, Abuse and Trauma, (IVAT). IVAT has been the fiscal sponsor since inception. The expo is organized by volunteers who, states producer Little, “wish to continue to build healthy communities globally.“
Wendy Jane Carrel, MA, is a Spanish-speaking senior care specialist and consultant from California. She has travelled Mexico for several years researching health systems, housing, senior care, and end-of-life care in order to connect Americans, Canadians, and Europeans with options for loved ones. She has investigated hundreds of senior living choices in 16 Mexican states. Her web site is http://www.WellnessShepherd.com
November 13-15, 2020 represented three full days of listening to and interacting with “conversations on the bench” via the new Hopin.com platform at the second annual Beautiful Dying Expo, produced by author and certified end-of-life midwife Michele Little of San Diego and San Francisco, CA.
Little, with co-host Kimberly C. Paul (filmmaker, creator Death by Design, and former hospice caregiver), guided an eclectic and worthy gathering of evolved, connected and compassionate folks dedicated to End-of-Life work. They shared best practices for advance health care planning, financial and estate planning, preparing for long-term illness or sudden illness, ancient traditions and rituals for end-of-life care, green burials, grief, and more.
Screen shot of Beautiful Dying Expo 2020 on-line with Kimberly Paul co-host and Expo Founder Michelle Litle
The expo goal according to Little? “To help you see more clearly about what’s involved in this journey and to provide you with new perspectives, resources, and connections… All of us are devoted to this sacred space.”
Participating thought leaders were from Australia, Argentina, Brazil, Canada, Costa Rica, Mexico, New Zealand, Puerto Rico, The Netherlands, South Africa, and the U.S. According to Little, there were attendees from 35 countries from outside the U.S.
In addition to the seminars, Little created a public space for one-on-one video chats and personalized advice with physicians, nurses, ombudsmen, social workers, lawyers, scientists, psychologists, music thanatologists, end-of-life doulas, and others.
This historic period with COVID at the forefront, and great numbers of people dying not only alone, but unprepared and without their wishes known, has brought more awareness, reflection, and discussions about dying.
Several folks working with those who are ill, near end-of-life, or working through the aftermath have been collaborating with colleagues in an accelerated way. This expo is one of many gatherings and events on-line since the onset of the virus.
One common theme among presenters and care panels was love – “love in the time of COVID” to borrow from Gabriel Garcia Marquez – providing support in a compassionate, collaborative, gentle, holistic way plus approaches to accomplish this.
Because some presentations overlapped, many worthy presenters and their subjects were not covered. Here a few highlights:
Of note was palliative care physician and gerontologist Karl Steinberg (a speaker at the 2019 expo) whose valuable talk focused on the importance of a relationship with your physician to state emergency, long-term care, and end-of-life wishes ahead of time. Steinberg is the current Vice President of the National POLST (Physician’s Order for Life Sustaining Treatment – known as a MOLST on the east coast). His expertise also extends to bioethics.
Screen shot of Dr. Karl Steinberg at Beautiful Dying Expo 2020 on-line
Another highlight was the session with Ken Ross, son of Elizabeth-Kubler Ross, the Swiss-American psychiatrist who normalized grief through many books, the most well-known of which is On Death and Dying. That particular book offers a model known as the five stages of grief. Ken Ross, a natural storyteller, was his mother’s caregiver the last 10 years of her life. He is carrying on his mother’s legacy through her worldwide foundation and foreign publication of her books. Ross regaled listeners with stories of travels to 20 countries with his mother. He clarified that his mother thought grief happened in cycles, and continues – it is not a cut and dry five stages.
The Elizabeth Kubler-Ross Foundation of Mexico, headed up by psychologist and end-of-life doula Wilka Roig, a Puerto Rican by birth, gathered a group of colleagues from other Elizabeth Kubler-Ross chapters around the world – Rodrigo Luz, a psychologist and thanatologist from Brazil, Else Groot-Alberts originally from The Netherlands but residing in New Zealand, Dr. Laura Aresca from Argentina and Uruguay, Wendy Pineda of Guatamala, and Cynthia Frahne a German psychotherapist devoted to palliative care in Argentina.
Screen shot of slide show from Ken Ross of Elizabeth Kubler-Ross Foundation, see Ken in upper left corner under the street sign bearing his motther’s name
Verna Fisher, a social worker, gave an endearing and sensitive talk about how to discover what is unsaid with both patients and families, how to show up for others, and how to listen.
Keith Bradley of Final Exit Network gave a valuable talk about Advanced Health Care Directives for Dementia, and John Tastad, a thought leader in end-of-life ethics, shared about truth-telling in a gentle way.
The closing hour with Brad Wolfe, creator of Reimagine, was especially heart-felt. Wolfe spoke about the death of his cherished grandmother and what it means to love someone all the way to the end of their life. An especially poignant moment was when his father Jim Wolfe joined the talk about this delicate subject. Reimagine is a platform to reimagine death. It has gathered over 65,000 attendees since its inception to discuss how to embrace life by facing death. See https://www.letsreimagine.org/about
Screen shot of Reimagine Founder Brad Wolfe with his father Jim Wolfe discussing delicate subject; Brad sings a song about beautiful dying
I was honored to attend and present at the first Beautiful Dying Expo last year in San Diego which you may read about here:
COVID has brought about loss of lives, economies, and untold devastation around the world.
It has also brought with it dedicated palliative care and end of life practitioners gathering for discussions about how to improve healthcare inequities and offer psycho-social-spiritual support to patients, families, medical teams, and first responders for now and the future.
New alliances and friendships have been formed via Facebook, Webinar, and Zoom chats that may not have been forged otherwise.
In August 2020, I attended several gatherings. Below are highlights. Each exchange was a gift.
The Chaplaincy Innovation Lab lead by Wendy Cadge and Michael Skaggs at Brandeis University continues to host a remarkable gathering of chaplains and others. The Trauma and Spiritual Care meeting in August emphasized the value of chaplaincy during COVID. We listened to moving stories about trauma created by the current medical model, especially for minorities, and the statement “racism is a public health crisis.” Also of note were observations by Dr. Ayo Yetunde, a professor at United Theological Center of the Twin Cities, who focused her remarks on the trauma and stigmatization of growing up black in America. She spoke about moral injury and how “politicians traumatize us.” Her newest book, to be released this fall is Black and Buddhist. See https://www.unitedseminary.edu/academics/faculty/pamela-ayo-yetunde/ and http://chaplaincyinnovation.org/
The Elizabeth Kubler-Ross Foundation of Central Mexico. Psychologist and end-of-life educator Wilka Roig in San Miguel de Allende produces monthly seminars related to death, dying, and grief. The August gathering was uncommonly interesting with Ken Ross, son of Dr. Elizabeth Kubler-Ross, as the guest. It was fascinating to learn about his mother, the Swiss doctor who spent her adult life in the U.S. devoted to continuing the hospice movement started by her friend and colleague Dame Cicely Saunders of St. Christopher’s Hospice, London. I have visited the Elizabeth Kubler-Ross library in Torrance, California at Dr. Ira Byock’s Institute of Human Caring but had no idea of the trials and tribulations of this remarkable woman’s life. Dr. Kubler-Ross was a Jungian, and a prolific author best known for Death and Dying, 1969. Ken was her caregiver for almost 10 years. He gave a loving, tender report that included amusing stories about how stubborn she could be. A revealing part of his talk was how most people interpret the five stages of dying or the five stages of grief literally, as fixed stages. He showed us circular graphs his mother created showing all phases are connected and that we go in and out of phases arbitrarily. There is no end.
Dr. Marcos Gomez Sancho, the pre-eminent thought leader for palliative care in the Latin world spoke on Facebook to over 700 physicians, nurses, social workers, psychologists, educators, and volunteers in North and South America from his home in Palma de Majorca, Spain. As anticipated his talk was well-planned and included music, paintings, and photos to illustrate his points. His presentation was “El Duelo Normal al Duelo Imposible”, normal grief to impossible grief, emphasizing “the cruelty” of dying alone without traditional support and the suffering of the patient, the family, and the medical team. Dr. Gomez’ website is: http://www.mgomezsancho.com/esp/index.php
I was honored to spend time with Dr. Gomez at the 2nd International Palliative Care Conference in Guadalajara in 2015 and last year when he was again the headliner at the 4th conference: https://wellnessshepherd.com/tag/dr-marcos-gomez-sancho/
Dr. Marcos Gomez Sancho, 2 August 2020
The National Association of Hindu Chaplains (NAHCA) A unique gathering of mostly Hindu Americans (14) with special guest Sanjay Mathur of the Hindu Temple of Rochester, NY. Moving stories by this tender-hearted man with compassionate presence. I could see why anyone would feel comfortable receiving his pastoral care. http://www.hindutempleofrochester.com/
Let’s Reimagine End of Life, based in San Francisco, has put a tremendous amount of energy into producing 700 “spaces” around the world, and 125 workshops. Congratulations to programmer Dara Kosberg. One of my favorite discussions included a small group of first generation Americans of Chinese, East Indian, Korean, and Thai descent discussing how to talk to their parents about planning end of life, a culturally taboo subject. On August 31, founder Brad Wolfe, a Stanford educated entrepreneur and artist hosted a chat with palliative care physician Jessica Zitter (also author and filmmaker), Pastor Corey Kennard, and grief author Hope Edelman. I loved the breakout sessions where a marvelous synchronicity introduced me to Jessica’s lovely mother Rhoda, and two colleagues whom I hope to stay in touch with – international end-of-life doulas Glynis German of Mallorca, Spain and Merilynne Rush, RN of Michigan. They both also host Death Cafes. Small, meaningful world. https://letsreimagine.org/
Heartfelt thanks to all those mentioned above who dedicate their lives to the well-being of others, and who are so willing to share what they’ve learned. And heartfelt thanks to all others engaged in these activities and are not mentioned.
The worldwide “death positive” movement of the last 10 years has encouraged many persons to prepare for their earthly demise – emotionally, physically, spiritually, and legally (addressing healthcare wishes, wills, and more).
The arrival of COVID has accelerated these discussions.
Many gatherings and programs focus on a return to “slow medicine”, person-centered care, traditional ways of honoring departures, the creation or continuation of rituals and all things “natural”.
Who is leading the conversations?
Here below is a random short list (many missing) of conferences and educational resources (mostly in the U.S.) about healthcare, death, dying, and transitions in 2020-2021. Consider it a starter list.
Not included are hundreds of insightful books by caregivers, chaplains, doulas, journalists, nurses, physicians, and lay folks, as well as numerous end-of-life doula programs, local civic community programs, and offerings from hospices, and faith-based organizations.
1001 thanks to all persons near and far who openly share information about mortality and ways to create a thoughtful, peaceful end-of-life for all (when possible) as part of their love mission.
Afterlife Conference The 10th annual conference, produced by Dr. Terri Daniels, a clinical chaplain, certified trauma professional, and end-of-life educator took place on-line in June. The 2021 conference is scheduled for next June. https://afterlifeconference.com/
Art of DyingInstitute at the New York Open Center. On-going seminars plus certificate trainings all year for end-of-life doulas, and dying consciously teachers. https://www.artofdying.org/
Association for Death Education and Counseling based in Minneapolis, MN cancelled its 42nd annual meeting for 2020. The next conference is scheduled for April 6-10 in Houston, TX. The conference offers continuing education credits and thanatology certifications. See www.adec.org
Authentic Presence On-going contemplative end-of-life care trainings and meditations led by interdisciplinary palliative care practitioners Kirsten de Leo, and Dr. Anne Allegre. Currently being held on-line. Notable professional education team https://www.authentic-presence.org/our-team
Café Mortality, Death Cafes, and Death Over Dinner. Groups around the world started gathering to discuss death over tea and cake in Switzerland in 2002 with sociologist Bernard Crettaz. In September 2011, American Jon Underwood, based in England, carried on the tradition by creating Death Café. Jon died not long ago but his wife, mother, sister, and other volunteers keep the organization going. There are Death Cafes in 79 countries!!! Find one near you or far from you (as most are on-line at this time of COVID) at www.deathcafe.com. Death Over Dinner continues in the same vein with night-time conversations about how we wish to die. See www.deathoverdinner.org. These are all volunteer efforts.
End of Life University. Dr. Karen Wyatt, an award-winning spiritual care author and hospice physician, started on-line podcast interviews (over 250) with end-of-life professionals in 2013 to offer a resource for family caregivers, healthcare workers, and the public. Dr. Wyatt also creates a book list every year, one book per month, known as The Year of Reading Dangerously. See http://www.eoluniversity.com and
Reimagine A non-profit organization based in San Francisco that “explores death and celebrates living.” On-going on-line conversations with a diverse group of participants – for example, an interview with palliative care physician Ira Byock, and a group of young Asian-American professionals focusing on how to address the subject of advance healthcare directives with their immigrant parents. For more info see www.letsreimagine.org
The Conversation Project. Boston-based non-profit, co-founded by Ellen Goodman, dedicated to helping folks talk about their wishes for end-of-life care at home and in community settings. Excellent materials (starter kits) to download and work with plus guidance for how to have your end-of-life wishes respected. They have a new COVID-19 specific guide which you may download for free as well as other resources. www.theconversationproject.org
University of Bath, UK The Centre for Death and Society, according to Director John Troyer, “is the only research centre that looks at death.” They held their 14th prestigious international conference in the fall of 2019. Their 2020 conference was cancelled but there are some continuing events including “Big Death Talks” https://www.bath.ac.uk/research-centres/centre-for-death-society/
University of Wisconsin International Death, Grief, and Bereavement Conference sponsored by the University of Wisconsin La Cross Center for Death Education, Bioethics, and Extended Learning. June 6-9, 2021 Call for proposals is open for the subject Ambiguous Loss and Grief.https://www.uwlax.edu/ex/dgb/
World Hospice and Palliative Care Alliance Last but not least, the most meaningful COVID healthcare conversations for me professionally were organized by WHPCA Executive Director Stephen R. Connor, PhD. Connor gathered palliative care professionals from Africa, Asia, Europe, Latin America, and the U.S. to review challenges related to caring, pain management, policy, resources, and serving during COVID. The series was on-line for 12 weeks and included collaboration with the International Association of Hospice and Palliative Care (IAHPC), International Children’s Palliative Care Network (ICPCN), and PALCHASE offering Palliative Care in Humanitarian Aid Situations and Emergencies. WHPCA has over 200 affiliate organizations and members in 79 countries. See https://www.thewhpca.org/covid-19/ for briefing notes and information on participants.
For those of you working in palliative care and hospice, or those of you interested in the subject of end-of-life, transitions, and grief, there are a vast number of educational and support opportunities sponsored by foundations, medical centers, universities, small groups, and individuals around the globe.
This year, I attended a new event in California…
Beautiful Dying Expo, November 2, 2019 which was founded and produced with love and attention by author (Exit Papers 101: Prepare for the Final) and End-of-Life Doula Michele Little at the San Diego Convention Center.
This first time gathering included palliative care and hospice professionals, educators, and volunteers; authors/philosophers/teachers/guides; green burial enterprises; music thanatologists; scientists, and, the public. A “Successful Aging” Expo, in full swing in an adjacent hall, brought curious older adults to attend as well.
According to Little, “Beautiful Dying Expo’s mission is to expand awareness and encourage meaningful conversation, demystifying the process of dying and death by bringing industry experts together to share current tools, new ideas and resources with the public.”
Noteworthy were the excellent panels moderated by author, podcast host, hospice physician, and founder of End of Life University on-line Karen Wyatt, MD. To read more about this extraordinarily dedicated educator and spiritual teacher please see www.EOLuniversity.comor
Karen Wyatt, MD, Author and Founder of End-of-Life University
The Comfort Measures and Caring for the Dying panel included Dan Diaz of End-of-Life Options (husband of Brittany Maynard who died of a brain tumor with assisted dying in Oregon), author, hospice nurse and chaplain Gabrielle Elise Jimenez (www.thehospiceheart.net), Sharon Lund (author and NDE near death experience speaker), Roger Moore a medical hypnotherapist, Elizabeth Padilla of the Conscious Dying Institute (www.ConsciousDyingInstitute.com ), Dr. Karl Steinberg palliative care physician, and Dr. Bob Uslander (Medical Director and Founder of Integrated MD Care).
Beautiful Dying Expo Advisory Board members San Diego palliative care physician Karl Steinberg, and Santa Barbara-based video and event producer Penny Little
The End-of-Life Choices and Planning panel included Scott T. Barton, PhD of UCSD School of Medicine’s Anatomical Department, estate attorney Adam Englund “the best bequest is to have your affairs in order”, Healthcare Chaplaincy member and speaker Ben Janzen (Dr Theology, PhD, VITAS Healthcare Chaplain and Bereavement Manager), Eric Putt, MBA of Thresholds Home and Family-Directed Funerals, Samantha Trad the California Director of Compassion and Choices, and Shawn LaValleur Adame founder of DIY Dying. Drs. Steinberg and Uslander also participated (see paragraph above for their details).
Also noteworthy were panels about Advance Care Planning, POLSTs (in California), end-of-life planning and options for veterans, end-of-life choices, and more. Among the unique exhibitors, workshop hosts, and musicians were Living Reef Memorials (“giving new life to our oceans”), Joshua Tree Memorial Park natural burials, Liz Fernandez DVM on pet euthanasia, Good Grief mandalas, and healing spiritual music from Gia George of http://www.divinelygia.com.
In honor of Mexico’s Day of the Dead it was an honor for me to share an overview of dying in Mexico – family and religious traditions, rituals, plus their origins and meaning told through stories I’ve been witness to based on two years as an educator and outreach liaison at www.JuntosContraelDolor.com – the only 24/7 palliative care hospital and hospice in the state of Jalisco, another two years dedicated to folks nearing end-of-life in a small village at Lake Chapala, and research volunteer work for www.HolaHospice.org to establish a senior home and hospice in the state of Michoacan.
Mexican paper mache’ Catrina dolls created by Professor Ernesto Eduardo Figueroa and his sister Ana of San Miguel Allende and Celaya. These dolls, dressed in French-influenced gowns from around 1900 telegraph that death is democratic and that even the wealthy do not escape it.
As a result of my expo presentation three hospice nurses, two bi-lingual, were excited to offer volunteer services in Mexico!! What a happy synchronicity, all due to Michele Little’s invitation for which I am grateful. Thanks also to Michele and team for creating a Day of the Dead altar in the middle of the expo room!!!!
Finishing touches were offered at 8:00 p.m. by idiosyncratic guest speaker Stephen Jenkinson, a Harvard-educated theologian and social worker, founder of Orphan Wisdom, and former director of palliative care at Mount Sinai Hospital in Toronto, Canada.
Canadian Stephen Jenkinson, author and speaker
Jenkinson has spent years of his life dedicated to promoting the acceptance of death and is the author of several books including the Nautilus Award-winning Die Wise: A Manifesto for Sanity and Soul. The National Film Board of Canada produced a documentary about Jenkinson and his philosophy entitled Griefwalker.
The 2020 educational event will take place in San Diego, CA October 31 and November 1.
In February 2019, El Ojo del Lago (The Eye of the Lake), an English-language publication at Lake Chapala, Mexico catering to 20,000 high season retirees from north-of-the-border, dedicated a section of its magazine to articles on End-of-Life.
Each contributor has worked in Senior Care and End-of-Life care for over 20 years. A piece I wrote was included. See the link (looks good there) or, you may read the copy below the link on this page.
ODE TO LOVE AND CAREGIVING AT A CHAPALA, MEXICO ART INSTALLATION
It is a notable synchronicity that “Transcendence – A Celebration of Those with Perseverance”, a medical art installation created by LK Gubelman (Leslie Katherine aka Kate), is located in El Sacrificio (the Sacrifice), Jalisco, Mexico.
Gubelman, an architect by profession, was caregiver to her retired and ill parents (mom Canadian, dad American) over the course of eight years at Lake Chapala, Mexico. Her creation is based on what she witnessed as she put her life aside to assist and honor her father and mother. The installation is also, she might share with you, how she has been meeting her irrevocable losses and sadness. The art has been her therapy.
The Transcendence exhibit in El Sacrificio is located inside “Los Conos”, cone-shaped granaries that continue to serve as art studio. Once you enter the big cone you cannot help but notice what is before you – six large scale works that required several years to complete (2015-2018) with the assistance of six men.
What will you see?
Depending on your own interpretation, the exhibit offers a way to reflect on life and death, from the point of view of the caregiver and Kate’s parents.
The largest of the pieces – THRESHOLDS – UMBRALES – is what you notice first. From the entrance, it resembles a beautiful stained glass window. Up close you see a symbolic body surrounded and connected by IV bottles filled with bright-colored water through plastic tubing. According to the artist, this piece is about time passing; each frame telling a tale of care given and the will to persevere. Every bottle was actually used at home.
Thresholds by Kate Gubelman
ENTANGLEMENT – ENREDO is a lattice work of medications, pills and pill boxes hung from the ceiling in suspended form, dazzling with crystal and beads linking one to another like Christmas decorations. Standing under it you cannot help but notice enormity of drugs consumed and what was required by caregiver Kate for medical management. All medication boxes and packets were used by Kate’s parents.
TRANSPARENCY – TRANSPARENCIA is a corridor of x-ray images, CT scans, MRIs mounted on translucent multi-colored panels described best by the publicist as “a tunnel of muted light and color…and a tale of medical machinery (cold steel) and the toll on all involved.” The names of Kate’s parents, Allison and Oscar, are on the panels.
Artist and caregiver Kate concludes, “there was no choice but to create the installation. It was a necessity, it helped my healing.”
Aside from honoring the wishes of her parents, and their lives, Gubelman bears witness to medical choices involved to keep her parents alive. Somehow, she felt compelled during the caregiving years, to collect and keep pill packages, intravenous bottles, medical records, x-rays, and other mementos.
Little did she know at the time they would become the basis of her installation.
What might you discover or experience?
You may instantly relate to Kate Gubelman’s art pieces, or not. According to Gubelman there are a variety of responses. Many visitors, both gringo and Mexican have felt either saddened or amazed. Many find deep meaning, especially recent widows and widowers who have been caregivers themselves.
Visitors have called the installation captivating, thought-provoking, emotional, and loving.
At minimum, you may feel sacrifice and perseverance were involved not only for Gubelman, but for her parents. An act of love? A comment on modern medicine? No matter your read, it is an immersive art experience.
Who might wish to see the exhibit Transcendence?
Caregivers, healthcare workers, perhaps those mourning the loss of loved ones, and, the general public
For more information or to schedule a private studio tour, please contact Bethany Anne Putnam
In January of 2018 Loretta Downs, M.A. gerontology, and I co-founded Death Café Ajijic aka Café Mortality Ajijic at Lake Chapala, Mexico.
The first café started the next month with the intention of encouraging the mostly retired community to talk about and prepare for end-of-life, not only to save loved ones and neighbors a lot of grief and time, but to provide a space to talk out feelings, hopefully leading to more well-being.
Because we travel a lot, we invited other health professionals in the community to join as volunteer hosts. We have been fortunate. There is now a rotating team to handle responsibilities for the all-volunteer events starting in 2019. We continue to do our best to improve the experience for attendees. One of the best ways for me to learn is to experience other Death Cafes.
For those of you unfamiliar with Death Cafes, they have been in existence since 2011 and are now in 63 countries of the world. See www.DeathCafe.com for a café near you.
I was recently in Santa Barbara, CA, originally a Spanish mission post, to attend the Santa Barbara Death Café.
It was a pleasure to enter the donated venue at 11 E. Carrillo Street, the Hill-Carrillo Adobe. Beautiful place built in 1825. It is on the National Registry of Historic Places.
Hill-Carrillo Adobe, circ 1825, Santa Barbara, CA
Hill-Carrillo Abode, Santa Barbara, CA
There are three dedicated hostesses in Santa Barbara. One of them provides her grandmother’s tea cups and linen. Others bring cake or cookies. Attendees offer donations to defray expenses.
Death Cafe Santa Barbara tea table
One of the surprises for me was that Santa Barbara Death Cafe provides a mobile library. They bring books in a large carton each month for participants to check out!! I love this idea!!
Death Cafe Santa Barbara lending library
Participants in Santa Barbara are all adults, mostly older adults. In a group of about 20, there were two men, one a recent widower. We introduced ourselves to each other at a long, rectangular table, one by one, sharing briefly what brought us to the café.
Conference table at Hill-Carrillo Adobe, Santa Barbara, CA
We dispersed after the introductions to talk in groups of three, four, or more. It was organic, and attendees were encouraged to move to another group if they so desired. I see how attendees return over and over again. The hostesses and environment feel cozy and safe.
Thank you Death Café Santa Barbara and Center for Successful Aging for your hospitality!!!
I also attended an intimate Death Café in Santa Monica a few days prior to the Santa Barbara Café. It was hosted by a lovely woman at her office space. She is a psychologist, grief counselor. death doula, and drama therapist from Pasadena. There were five of us all together. The counselor led by asking why each came, and the other three participants, each in their 30’s, were off and running, lively and engaged from the start. Time went by quickly. This multi-talented lady also offers a Death Goes to the Movies night. Recently she screened a documentary about a psychiatrist/musician preparing for his green burial.
Both cafes in Santa Barbara and Santa Monica were unique, rewarding experiences. You may find the next dates for these Death Cafes or others near you at http://www.DeathCafe.com. If you do not find one, perhaps you may have a desire to start one.
Please see the following links for articles about two of the cafes in Ajijic if you are interested – how we organized, and how attendees shared experiences at the end.
For the last few years I have had the good fortune to visit palliative care and hospice entities in California as well as in six states of Mexico with the objective of learning more about what works, what’s missing, and what might work in Mexico for years to come. There are challenges based on cultural differences, but all is possible.
I am comparing various models – hospitals and facilities (medical), in-home community outreach (medical and/or volunteer), all volunteer, government, non-profit, and for profit.
Hospice of San Luis Obispo County (HSLO) has been on my radar for some time because it is a successful, locally based non-profit volunteer hospice that has sustained itself for 41 years!! For those of you who are familiar with the operations of non-profits, this is an extraordinary achievement.
Aside from serving the public, HSLO educates and trains locals and others as end-of-life doulas (companions). They host Death Cafes and much more.
The sustainability is based on more than dedication and love – mainly inventive ways to engage the public, an especially hard task in a difficult economy.
Hospice of San Luis Obispo County, California office
I am so pleased I was finally able to visit HSLO. I am indebted to the Executive Director and the Director of Volunteers, the few paid staff, for a warm, meaningful, memorable exchange.
HSLO is one of six hospice services in a county with a population of around 284,000. It is the only volunteer in-home hospice supported by the generous energy of over 200 volunteers. They serve approximately 5,000 persons per year.
Any county resident with life-limiting illness is served through “in-home respite care, emotional, spiritual, practical and non-medical support, and grief counseling support (group and individual).”
Other services are education about dying and death for professionals, caregivers and the community, doula programs, Death Cafes, Threshold Choirs, and Pet Peace of Mind groups.
From my perspective their outreach and activities place HSLO in the vanguard of the “death care and the death positive” movement that is sweeping North America and beyond. It is exhausting but rewarding work.
Additional treat: I was blessed to attend HSLO’s annual Light Up A Lifecandlelight vigil held at the San LuisObispo Mission on a nippy, rainy evening. Names of those who have passed were read out loud during the hour service that included a choir. Later we carried candles outside for readings and prayers.
Light Up A Life Candlelight Vigirl, San Luis Obispo Mission, California
Anyone may pay a fee (fundraising) to have the name or names of loved ones read at Light Up A Life. This lovely event is repeated during one week in December in different cities of the county.
HSLO was created in 1977 and has an excellent reputation through word-of-mouth.
Services are provided without charge; no insurance company is billed.
HSLO relies on community donations, fundraising events, grants, doula training fees, and the time of its over 200 volunteers.
Hospice of San Luis Obispo County is a remarkable operation. So much goodwill!! A great gift to the community.
The home which serves as office was bequeathed to HSLO by Dorothy D. Rupe; it bears her name.
1304 Pacific Street, San Luis Obispo,CA 93401 tel. (805)544-2266
While conducting research on health care and end-of-life options for older adults in Mexico, and volunteering at a Guadalajara palliative care hospital and hospice, I have witnessed both expected and unexpected deaths of Americans, Canadians, other foreigners, and Mexicans. In the case of Mexicans, the procedure following death is almost seamless, with rare exception.
Chapala Municipal Cemetery, Lake Chapala, Mexico
The question is, how will you prepare for such a situation if you are not Mexican?
Here is some of what I’ve learned in expat havens from Alamos to Ajijic, Mazatlan to Merida, and Tijuana to Oaxaca:
If you wish to save your family, other loved ones, and your neighbors considerable grief and time, it is important to understand what is involved when a foreigner dies in Mexico, and, to have a plan in place.
This goes for 18-year olds, 40-year olds, and especially for all persons over age 60.
Even though the subject is one many of us prefer to avoid, family and friends back home, as well as your local neighbors, will be grateful if you plan ahead. Planning ahead might even give you peace of mind!
WHAT TO BE AWARE OF
The system of law is different. If you are from Canada, England, or the U.S., you are accustomed to common law, not civil law based on Napoleonic code. The rules governing disposition of human remains in Mexico are not the same as at home. The time and bureaucratic requirements required to negotiate the Mexican system, post-death, can be daunting.
Mexico is a country with predominantly Catholic traditions. These traditions influence choices. If you are Catholic, the system may seem familiar, such as burial over cremation. If you had chosen to live in Buddhist or Hindu Asia, cremation would be a relatively easy matter involving fewer steps as cremation is common practice. Or, you could have opted for a Tibetan sky burial.
The Mexican culture, language, and way of thinking are unique. Most of all, procedures may be unfamiliar and complex.
PREPARING AHEAD FOR YOUR DEMISE & DISPOSITION OF REMAINS IN MEXICO
The key Mexican legal document you need to acquire for best outcomes is a “declaración jurada ” (more or less the equivalent of a living will) stating burial or cremation wishes. This document must be created before your demise. The declaración jurada will almost always insure your plan is followed. It is usually prepared by notaries (notarios). Current costs are approximately 1000 pesos in Jalisco state, for example. Note: powers of attorney (equally important for pre-death and health care complications), and wills regarding your property are separate documents. Once a year, older adults can receive a 50% discount in the month of September for wills relating to property (home, car, jewelry, and other assets).
Note: Some funeral homes offer notarized Letters of Intention for cremation or burial. This, in addition to your declaración jurada, is a somewhat reliable back-up. These funeral homes will give you a card to carry on your person at all times; the card contains your name and other details plus their contact information. Not all funeral homes offer this service. There is now the option of green burial in the state of Guanajuato through the Elizabeth Kubler-Ross Foundation in San Miguel de Allende.
Your Advance Health Care Directive or Five Wishes from home is not valid in Mexico even if notarized, apostilled and translated into Spanish unless you get lucky.
You are best off incorporating preferences from your Advance Health Care Directive or Five Wishes (https://fivewishes.org/) in your Mexican legal document. Most legal documents for foreigners, unless you live in a rural area, are written in Spanish on one half of the page, and English on the other. Again, this is the most important document you can obtain relating to your end-of-life wishes. Note: there is no guarantee your healthcare requests will be honored by doctors, hospitals, and ambulance services, just as in your home country. Your cremation request will be honored if it is in writing and your papers are presented.
Burial in Mexico
Burial in Mexico could be easier than shipping a casket home and less expensive, with one exception. Many cemeteries offer plots for purchase for a set period of time (usually six years) with the understanding that remains will be removed and buried elsewhere at the end of that period. Arrangements must be made in advance for relocation of remains or they may be removed to a communal grave.
Note: There is less and less room at cemeteries in heavily populated areas. According to some city Pantheon (cemetery) directors, families with plots are burying loved ones 10 persons deep.
The population from Chapala to Jocotopec (north Lake Chapala) just south of Guadalajara, for example, is around 100,000, including 20,000 full-time ex-pats (numbers not exact). There are approximately 80+ deaths per year among the ex-pat community according to Chapala’s Registro Civil, Civil Registry office.
Ajijic Cemetery along Lake Chapala serves a population of 10,000. It is full unless a family will sell you a plot there.
Ajijic Cemetery, Lake Chapala, Mexico
Cremation in Mexico
When death occurs in Mexico, local practices will govern how quickly a cremation can take place. In the state of Jalisco burial or cremation must be within 48 hours, or the body must be embalmed. There is one exception – a body can lie up to 30 days in refrigeration (if refrigeration is available and with permission) awaiting family members from out of country to view the remains. Then cremation or interment will take place. Cost for cremation in Jalisco, for example, is approximately 10,000 -15,000 Mexican pesos; costs for embalming, around 5,000 Mexican pesos. The prices escalate every year.
In Mexico your legal next-of-kin may request cremation or interment if you do not have a notarized living will with end-of-life wishes. It is unwise, however, to depend on good luck or miracles in this situation – again, best to have a Mexican living will.
Some churches in Mexico offer space for cremated remains in an urn or box in a mini-mausoleum setting. Here again, you are usually paying for a specified number of years.
Note: According to a U.S. Consulate web site, “if the deceased is to be transported between states in Mexico for cremation, the body must be embalmed. If the body is to be transported over 100 km a special transit permit is also required.”
Crematories
By law, a body is to be identified ahead of time. In Guadalajara, for example, no toe tags are used. Photos are taken of faces before the procedure. The name of the person is also written on a ticket. That ticket, serving as I.D., is inserted into a slot space outside the crematory machine.
Crematory Center, Guadalajara Municipal Cemetery, Mezquitan Country
Shipment of Remains Outside of Mexico
If you are American and wish your ashes or remains sent home, there is another step for a loved one or trusted advocate to complete after all Mexican death-related documents are obtained. (If you are Canadian, see the links in the Resources section below. Canadian procedures are not the same as American procedures). If your body has been cremated, a cremation certificate from the funeral home, an affidavit from the funeral director, and an original copy of the death certificate must be delivered to the nearest Embassy or Consulate. (See U.S. Government 7 FAM 258 DOCUMENTS TO ACCOMPANY REMAINS; these regulations were last updated January 18, 2013). If you die in a small city or rural area and cremation is your preference, understand the expense, effort, and permissions needed to fulfill this requirement.
According to the U.S. government, a consular officer will prepare a consular mortuary certificate to ensure “orderly shipment of remains and facilitate U.S. Customs clearance.” The certificate will be delivered to you in English and it will contain the essential information including cause of death.
As for shipment of remains in a casket, a U.S. consular officer will work to ensure that the Mexican funeral director and American funeral director are in communication to guarantee preparation of remains complies with local, U.S. Department of State, and federal requirements. All corpses going to the U.S. must be embalmed. The shipping time is approximately seven days.
Also note: DHL, Federal Express, and embassy diplomatic pouches cannot be used to ship cremated remains out of the country. There is no customs fee to ship remains to the U.S. Note: Shipment of remains outside of Mexico involves not only high cost, but red tape. Consider buying repatriation of remains insurance.
Other Details to Consider for Smoother Disposition of Remains in Mexico:
Someone to Act on Your Behalf
Are you living alone? If so, do you have at least three friends or neighbors who will follow through with your wishes and instructions if you die in Mexico? Note: Do not depend on legal next-of-kin (spouse) or significant other to represent you. What if you both die in a car accident or other tragedy? It is best to delegate additional persons or a trusted attorney to take charge.
A Physician
Do you have a working relationship with a medical doctor who can be called immediately by the designated person or persons to declare cause of death and write the death certificate so an autopsy can be avoided? Do not call 911,an ambulance (Cruz Roja or Cruz Verde), the fire department (bomberos), or the police. Call the doctor, obtain the death certificate (Certificado de Defunción – delivered with three copies), then call the funeral home. The copies of the certificate are then delivered to the local Civil Registry (Registro Civil), the Ministry of Public Health, and INEGI (the National Statistics Office).
In places with a number of expatriates, funeral homes sometimes have doctors who can appear if your doctor is on vacation, but most doctors prefer a relationship with you before they will appear and sign a death certificate. Note: If foul play is suspected, an autopsy will be required and the police and fiscalia (the district attorney’s forensics department) will be involved.
Funeral company
Have you selected a funeral service or transporter to collect your body and handle your remains? Using a funeral service is necessary in most of Mexico, unless you are in a remote, rural village where you may be buried in a local cemetery.
Guadalajara Municipal Cemetery, Mezquitlan Country
Organ donation
Do you want your organs donated? Mexico City’s UNAM, Programa de Donacion de Cuerpo, for example, will welcome your body for science. Are your wishes written in your living will or indicated on your Mexican driver’s license?
Where to Place Remains. Do you wish your remains to stay in country or shipped home?
Chapala Municipal Cemetery, Lake Chapala, Mexico
Someone to Act on Your Behalf, Part 2
Again, designate at least three people to be in charge of your affairs in Mexico in the immediate aftermath of your death. This is recommended based on witnessing situations in Ecuador and Mexico over a period of 12 years, and accompanying distressed family members. Your ex-pat friends may travel quite a bit or may not be present at the time.
Do your designees know which funeral service or transporter will collect your body? Do they know where your legal documents (passport, INM immigration green card, living will – specific for cremation or burial, contact info) are and how to pay the funeral home if not pre-paid? Do they know where to locate your bankcard, cash, and/or documents 24/7? Do they have a copy of your keys? Plan on leaving about 20,000 Mexican pesos or more for the certifying doctor, transportation, the funeral company, Civil Registry fees, and cremation so your friends are not left to raise funds.
Copies of Documents. There must be several copies of critical documents – passport, residence card, living will, death certificate, mortuary certificate, affidavit of Mexican funeral director, transit permit, et altri. The person(s) in charge must be told not to offer an original document to transit people, most bureaucrats, etc. – in most instances these entities receive copies.
Death Certificate (Acta de Defunción)
Who will obtain the Mexican government declaration of death with the appropriate stamps from the Civil Registry and the Ministry of Public Health? This is not only a death certificate but an authorization for burial or cremation. Some Mexican funeral homes have experience assisting with these matters, others not. Will your designees need to do it? Best to find out how to obtain the certificate in the state or province where you live so you can leave instructions. (See Resources section below the article with links to information about death certificates in Mexico).
Register Death with Your Country’s Embassy or Consulate
Who will obtain the proper documents from the U.S. Embassy or Consulate, the Canadian Embassy or Consulate, or other foreign government representative in Mexico not only to register the death, but for remains transported home? Some funeral homes are accustomed to offering this service, others not. The embassy or consulate will prepare a Report of Death from the death certificate. Your family member or representative will use this document along with the Mexican documents if or when remains are transported out of Mexico. At the U.S. Consulate you are entitled to 10 to 20 original copies in English.
Spanish language skills are imperative
Depending on English-speaking Mexicans during this process is not advised as they may not be available when you need them. Have someone at the ready who can negotiate procedures in Spanish. There are a number of facilitators, translators, and attorneys who speak English or other languages, best to keep their information handy.
What happens if you die in Mexico, have no spouse, no next-of-kin, no legal documents stating your wishes, and no legal representatives?
Your body will probably be transported to a morgue, usually a SEMEFO (Servicio Médico Forense – Medical Forensic Service) building with refrigeration. Not all SEMEFO buildings have refrigeration or space, even if they have refrigeration. See video links at end of article with tours of SEMEFO in Guadalajara, Mexico City, Sinaloa and the Yucatan. Your country’s representatives will be called. Each country has different procedures for handling such situations. Your body will probably be autopsied. Often, if no one claims your body, your remains will be placed in a communal grave in Mexico. Each state of Mexico and each rural area has different traditions and preferences.
Few people know where they will die or when. If you spend time in Mexico, or any Latin American country with deeply Catholic traditions, where family ties and support reign (i.e. you will be rescued and your loved ones will know what to do), as well as strict codes and preferences that may not be yours, please choose to prepare yourself.
Preparation hint: register your whereabouts and family contact information with your embassy or consulate The U.S. government, for example, has an excellent system for Americans at https://step.state.gov/. It is the Smart Traveler Enrollment Program and advises you of security risks in the place where you are living and assists with connecting family and others to you in case of emergency. Other places to register your emergency information are located in expat communities around the country. The registries are usually announced in local directories, magazines, English-language newspapers, or found by word-of-mouth. Some non-profit expat organizations provide registries as do churches and synagogues with English-speaking congregations.
End-of-Life Planning is critical for expats.
Create peace of mind for yourself, your loved ones, and your neighbors.
Note: Preparing medical directives for healthcare emergencies, and preparing wills, are subjects worthy of their own long articles and are not included above.
Note two: Physicians, funeral directors, cemetery directors, city and province officials (including a district attorney forensics office), one attorney, one notary, and a consulate were consulted with or interviewed in Mexico for this article.
Note three: If you are alone with no spouse, no children, and no one to rescue you, it is suggested you carry a copy of the funeral home card with contact information on you, plus a copy of key contacts including the notary public. When traveling, also carry a copy of your declaración jurada. If you have a car, it is recommended you keep a copy of your declaración jurada in the glove compartment.
Wendy Jane Carrel, MA, is a Spanish-speaking senior care specialist and consultant from California. She has travelled Mexico for several years researching health systems, housing, senior care, end-of-life care and planning, and, disposition of remains in order to connect Americans, Canadians, and Europeans with options for loved ones. She has investigated hundreds of senior living choices in 16 Mexican states. Her e-mail is wellnessshepherd@aol.com. Her web site is http://www.WellnessShepherd.com,
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https://wdef.com/2018/09/19/morgue-director-fired-over-stench-of-157-corpses-in-truck/ September 2018 article reporting on two tractor trailers filled with unidentified corpses as there is not enough refrigerated space at the morgue in Guadalajara. A report by the English-language Guadalajara Reporter stated that corpses of two unrelated Americans, who died of natural causes, were stored in the tractor trailers, an indication that some stored corpses were identified first, not that it makes being stored in a tractor trailer palpable.
https://www.youtube.com/watch?v=kWNr53cWfxk Sinaloa SEMEFO, a report in Spanish about abandoned corpses and no refrigeration 2016, “muerte indigna.” Apparently a new building has been constructed since with refrigeration. Note: in places of extreme humidity and heat with no refrigeration, imagine the stench.
https://www.youtube.com/watch?v=5fNXN6XycPA According to the video, “drug dealer” tombs in Sinaloa represent the opposite kind of ending from an abandoned body left at the morgue. The Jardines de Humaya cemetery in Culiacán, Sinaloa, is known for its extravagant mausoleums, not all that dissimilar from the concept of the Mamluk tombs in Cairo Egypt’s City of the Dead (circa 642 AD). The video shows the tomb of Ignacio Coronel that apparently cost millions of pesos or dollars.
https://www.youtube.com/watch?v=B-mHof2axB4 According to this 2017 documentary video from Mexico City, if after three weeks no one identifies a body, it will usually end up in a communal grave. In another report, some bodies may go to a medical school for study.
https://tomzap.com/dying.html Dying in Puerto Escondido, Oaxaca, a 2013 report. At that time it was estimated one needed about 12,000 pesos to pay for cremation, now transportation and cremation will come to around 20,000 pesos, depending on the funeral home.
Wellness Shepherd 
